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Comparison Between In-Person and Audio-Only Virtual Prenatal Visits and Perinatal Outcomes

Educational Objective
To identify the key insights or developments described in this article
1 Credit CME
Key Points

Question  Were audio-only virtual prenatal visits during the COVID-19 pandemic associated with a change in perinatal outcomes in a vulnerable population?

Findings  In this cohort study of 12 607 women, 173 women (2.9%) experienced placental abruption, stillbirth, cord pH less than 7.0, or full-term neonatal intensive care unit admission, which was not significantly different than the 195 women (3.0%) affected in 2019. The rate of this composite outcome also did not differ significantly when stratified by the number of virtual prenatal visits.

Meaning  In this study, women who delivered in 2020 following implementation of audio-only prenatal virtual visits did not experience more adverse pregnancy outcomes than women who delivered in 2019.


Importance  Ensuring access to prenatal care services in the US is challenging, and implementation of telehealth options was limited before the COVID-19 pandemic, especially in vulnerable populations, given the regulatory requirements for video visit technology.

Objective  To explore the association of audio-only virtual prenatal care with perinatal outcomes.

Design, Setting, and Participants  This cohort study compared perinatal outcomes of women who delivered between May 1 and October 31, 2019 (n = 6559), and received in-person prenatal visits only with those who delivered between May 1 and October 31, 2020 (n = 6048), when audio-only virtual visits were integrated into prenatal care during the COVID-19 pandemic, as feasible based on pregnancy complications. Parkland Health and Hospital System in Dallas, Texas, provides care to the vulnerable obstetric population of the county via a high-volume prenatal clinic system and public maternity hospital. All deliveries of infants weighing more than 500 g, whether live or stillborn, were included.

Exposures  Prenatal care incorporating audio-only prenatal care visits.

Main Outcomes and Measures  The primary outcome was a composite of placental abruption, stillbirth, neonatal intensive care unit admission in a full-term (≥37 weeks) infant, and umbilical cord blood pH less than 7.0. Visit data, maternal characteristics, and other perinatal outcomes were also examined.

Results  The mean (SD) age of the 6559 women who delivered in 2019 was 27.8 (6.4) years, and the age of the 6048 women who delivered in 2020 was 27.7 (6.5) years (P = .38). Of women delivering in 2020, 1090 (18.0%) were non-Hispanic Black compared with 1067 (16.3%) in 2019 (P = .04). In the 2020 cohort, 4067 women (67.2%) attended at least 1 and 1216 women (20.1%) attended at least 3 audio-only virtual prenatal visits. Women who delivered in 2020 attended a greater mean (SD) number of prenatal visits compared with women who delivered in 2019 (9.8 [3.4] vs 9.4 [3.8] visits; P < .001). In the 2020 cohort, 173 women (2.9%) experienced the composite outcome, which was not significantly different than the 195 women (3.0%) in 2019 (P = .71). In addition, the rate of the composite outcome did not differ substantially when examined according to the number of audio-only virtual visits attended.

Conclusions and Relevance  Implementation of audio-only virtual prenatal visits was not associated with changes in perinatal outcomes and increased prenatal visit attendance in a vulnerable population during the COVID-19 pandemic when used in a risk-appropriate model.

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Article Information

Accepted for Publication: February 23, 2021.

Published: April 14, 2021. doi:10.1001/jamanetworkopen.2021.5854

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2021 Duryea EL et al. JAMA Network Open.

Corresponding Author: Elaine L. Duryea, MD, Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390 (elaine.duryea@utsouthwestern.edu).

Author Contributions: Drs Duryea and McIntire had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: All authors.

Acquisition, analysis, or interpretation of data: Duryea, Ambia, Spong, McIntire, Nelson.

Drafting of the manuscript: All authors.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: Duryea, McIntire, Nelson.

Administrative, technical, or material support: Duryea, Spong.

Supervision: Duryea, Adhikari, Spong, Nelson.

Conflict of Interest Disclosures: None reported.

Funding/Support: Internal funding from the academic department of Obstetrics and Gynecology at University of Texas Southwestern supported this study.

Role of the Funder/Sponsor: The funding organization had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

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